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Senior Member
Join Date: Mar 2006
Posts: 4,778
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the "cost" of cancer--I bet the her2group members could tell them a thing or 2!
Study Calculates Patient Time Costs Associated with Cancer Care [Journal of the National Cancer Institute]
In 2005, the overall cost of patients' time spent on cancer care was $2.3 billion in the first year after diagnosis, according to a new study in the January 3 issue of the Journal of the National Cancer Institute. The time costs for the 11 cancers studied and for different phases of cancer care varied widely, they write.
Several studies have estimated the direct medical costs of cancer care, but few have attempted to include a patient's time associated with cancer care, such as time spent traveling to and from care, waiting for appointments, and receiving services and treatments, all of which represent time not spent working or pursuing day-to-day activities.
In the new study, Robin Yabroff, Ph.D., of the National Cancer Institute, and colleagues quantified the patient time costs associated with cancer care. They used information from the Surveillance, Epidemiology, and End Results-Medicare database on more than 760,000 patients with 11 different types of cancer and from 1.1 million Medicare enrollees without cancer. Using data from 1995 to 2001, they estimated each patient's time spent at physician and emergency room visits, chemotherapy treatments, radiation therapy, hospitalizations, outpatient surgeries, and imaging procedures. They then estimated how long each patient spent traveling to, waiting for, and receiving care. The net costs were calculated using a dollar value of $15.23 per hour, the median U.S. wage rate in 2002.
During the first 12 months after diagnosis, the average length of time for hospitalization was highest for patients with gastric and ovarian cancers (21.1 and 20.8 days) and shortest for patients with melanoma (2.2 days), prostate cancer (3.8 days) and breast cancer (4.0 days). Compared to similar people without cancer, cancer patients' net time associated with medical care varied, ranging from 17.8 hours for melanoma to 351.3 hours for gastric cancer and 368.1 hours for ovarian cancer. When the researchers applied the dollar costs to time spent on medical care in the first 12 months after diagnosis, they found that net patient time costs were lowest for melanoma ($271) and prostate cancer ($842) and highest for gastric ($5,348) and ovarian ($5,605) cancer.
In the last year of life, hospitalization time was longest for patients with gastric (35.4 days), lung (32.4 days), and ovarian (31.9 days) cancer. Estimates of patients' net time spent on medical care were lowest for melanoma (99.1 hours) and highest for ovarian (485.3 hours), lung (488.3 hours), and gastric (512.2 hours) cancer. They calculated that the net patient time costs during the last year of life ranged from $1,509 for melanoma to $7,799 for gastric, $7,435 for lung, and $7,388 for ovarian cancer. Hospitalizations were the largest component of patient time costs in both the initial year after diagnosis and in the last year of life.
"For 2005, the estimated cost for the initial phase of care alone was approximately $2.3 billion," the authors write. These estimates could be combined with estimates of direct and indirect costs to better understand the overall burden of cancer in the United States, the authors write.
"What we see here is a measure of the patient's burden of commitment—measured in dollars—associated with receiving today's cancer therapy," write Larry G. Kessler, Sc.D., of the U.S. Food and Drug Administration and Scott D. Ramsey, M.D., Ph.D., of the Fred Hutchinson Cancer Research Center in Seattle, in an accompanying editorial. "We hope that policy makers recognize the substantial economic burden of cancer in the United States and that this cost derives from many sources ... ."
The editorial writers also note that these calculations do not address the emotional cost cancer patients and their families endure. Even accounting for patient time costs, "we know we have greatly underestimated the true cost of the disease," they write. Nevertheless, Kessler and Ramsey conclude, new treatments that reduce patient time costs should be encouraged, and manufacturers should quantify these benefits and then convey them to patients, providers, and health insurers.
ABSTRACT: Patient Time Costs Associated With Cancer Care [Journal of the National Cancer Institute]
Background: Although costs of medical care for cancer have been investigated extensively, patient time costs associated with cancer care have rarely been estimated systematically. In this study, we estimated patient time costs associated with cancer care in patients aged 65 years and older in the United States.
Methods: We identified 763 527 patients with breast, colorectal, corpus uteri, gastric, head and neck, lung, melanoma of the skin, ovary, prostate, renal, and urinary bladder cancers from linked Surveillance, Epidemiology, and End Results-Medicare files and 1 145 159 noncancer control subjects among Medicare enrollees who were matched by sex, age-group, and geographic location. Frequency of service use was calculated by category for patients and control subjects using Medicare claims data from 1995 to 2001. For each service category, time estimates were combined with service frequency and an hourly value of patient time. Net patient time costs were summed in the initial, continuing, and last-year-of-life phases of care for each tumor site. Net time cost estimates for the initial phase of care were applied to national estimates of numbers of new cancers in 2005 to obtain national time costs for the initial phase of care.
Results: Net patient time costs during the initial phase of care ranged from $271 (95% confidence interval [CI] = $213 to $329) and $842 (95% CI = $806 to $878) for melanoma of the skin and prostate cancer, respectively, to $5348 (95% CI = $4978 to $5718) and $5605 (95% CI = $5273 to $5937) for gastric and ovarian cancers, respectively. Net patient time costs for care during the last year of life ranged from $1509 (95% CI = $1343 to $1675) for melanoma of the skin to $7799 (95% CI = $7433 to $8165), $7435 (95% CI = $7207 to $7663), and $7388 (95% CI = $7018 to $7758) for gastric, lung, and ovarian cancers, respectively. In 2005, patient time costs for the initial phase of care were $2.3 billion.
Conclusions: Patient time costs for cancer care in the United States are substantial and vary by tumor site and phase of care, likely reflecting differences in stage at diagnosis and availability and intensity of treatment.
OPEN ACCESS: EDITORIAL: The Forest and the Trees: the Human Costs of Cancer [Journal of the National Cancer Institute]
What are the implications of these findings? We already know that cancer is costly to society. One potentially valuable use of these estimates is to inform those responsible for the development of public policy regarding cancer, such as for the funding of the wide variety of research that National Cancer Institute has become known for since 1971. We hope that policy makers recognize the substantial economic burden of cancer in the United States and that this cost derives from many sources: direct medical costs, patient time, lost wages and productivity, and family time and costs. The time costs of cancer and their implications for society should be considered in debates regarding the level of public funding for cancer research.
Cost-of-disease studies have proven useful for the general debate about health care policy and for assessing burden on the population. The value of understanding the scope of the human costs of cancer most likely lies in our desire to appreciate the impact of the disease in its many manifestations and, perhaps, in using some of these findings as a guide to assert the importance of trying to reduce the morbidity and mortality due to this disease. It also continues to reinforce the importance of strategies such as early detection, which in turn will both directly and indirectly reduce the cancer burden.
Treatments that reduce time costs while maintaining or improving efficacy should be encouraged. Manufacturers of new cancer therapies that reduce patient time costs should quantify these benefits because they improve the value of the products. Similarly, health insurers should consider rewarding manufacturers of therapies that reduce both direct medical and direct nonmedical costs, even though the latter do not enter into their bottom line.
Does this study complete the picture of the overall burden of cancer? We have left out the incalculable emotional suffering of the patient and his or her family and friends. Without such a count, we know we have greatly underestimated the true cost of this disease. The goal over time should be the reduction of the disease and, of course, the reduction of its cost to the public health.
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